Provider Demographics
NPI:1669506655
Name:ZEDARAN, ELIZABETH HODUN (PHD)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:HODUN
Last Name:ZEDARAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:INFINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 852051
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75085-2051
Mailing Address - Country:US
Mailing Address - Phone:972-403-1359
Mailing Address - Fax:972-403-1378
Practice Address - Street 1:1401 N CENTRAL EXPY
Practice Address - Street 2:#375
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4669
Practice Address - Country:US
Practice Address - Phone:214-793-0158
Practice Address - Fax:972-644-7220
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16554101YM0800X
TX4811106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85226LOtherBCBS PROVIDER#